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Moulaei K, Kazemi-Arpanahi H. Applications, benefits, and challenges of adopting teleurology: a scoping review. World J Urol 2025; 43:330. [PMID: 40423718 DOI: 10.1007/s00345-025-05706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Accepted: 05/13/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND Urological diseases present substantial challenges for patients, including restricted access to specialized care, prolonged wait times, and geographical barriers, particularly in underserved and rural regions. Teleurology leverages telecommunication technologies to enable remote consultations, improve patient monitoring, and enhance access to specialized care. This scoping review aims to systematically examine the applications, benefits, and challenges associated with teleurology, offering a comprehensive analysis of its role in contemporary urological practice. METHODS The PRISMA-ScR guidelines was followed to perform this scoping review. Systematic searches were performed in PubMed, Scopus, and Web of Science, covering publications from 2010 until January 19, 2025. Two trained reviewers independently retrieved, screened, and extracted the data. RESULTS The initial search identified 2,080 studies. After removing 500 duplicates, 1,577 unique studies remained for title and abstract screening. Ultimately, 49 articles were selected for data extraction. The most frequent teleurology communication interventions were Telephone (n = 12) and Videoconferencing (n = 11). Teleurology services were predominantly delivered through synchronous modalities (77%), followed by a combination of synchronous and asynchronous approaches (18%). Tele-consultation (n = 18), Tele-visit (n = 15), and Tele-care, in that order (n = 8) were the most common applications. A total of 339 benefits (n = 216) and challenges (n = 123) for teleurology were identified, with 28 benefits and 13 challenges remaining after consolidation. "Reducing patient treatment expenditures, travel costs and time" (n = 30), "Increasing patient satisfaction with telemedicine services" (n = 23), "Access to care for patients in rural or underserved areas" (n = 17), and "Curbing disease spread and sustaining care during pandemics while maintaining distancing" (n = 17) were the most common benefits of teleurology. The most important challenges were "Lack of physical examination of patients during telemedicine visits" (n = 30), "Need for robust digital infrastructure (inaccessible to technology, computer and internet)" (n = 23), and "Patient concerns about confidentiality and privacy" (n = 18). CONCLUSIONS Teleurology improves access, reduces costs, and enhances patient satisfaction, especially in underserved areas. However, physical exam limitations, infrastructure gaps, and privacy concerns remain challenges. Future efforts should refine teleurology frameworks and strengthen digital infrastructure for secure, high-quality care.
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Affiliation(s)
- Khadijeh Moulaei
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Artificial Intelligence in Medical Sciences Research Center, Smart University of Medical Sciences, Tehran, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran.
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Abou Chawareb E, Nakamura H, Hammad MAM, Miller JA, Lumbiganon S, Azad BK, Yafi FA. Search traffic for inflatable penile prosthesis increased following the COVID-19 pandemic in the United States: a Google Trends analysis. Int J Impot Res 2025; 37:361-365. [PMID: 38816575 PMCID: PMC12088982 DOI: 10.1038/s41443-024-00922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
We aimed to determine the impact of the COVID-19 pandemic on search trends for inflatable penile implants in the US. Search trends for inflatable penile implants ranging from 2016 through 2023 were analyzed utilizing Google Trends. Associations between search trends and US Census Bureau data, including average household income and per capita income, were analyzed. Pre- and post- COVID-19, the interest in inflatable penile implants has been steadily increasing on average in the US. The average household income for counties with the highest interest in inflatable penile implants during the pre-COVID era was $53,136, whereas for the counties with the highest interest in inflatable penile implants in the post-COVID era, the average decreased to $50,940. Similarly, the average per capita median decreased from $35,209 to $34,547. Search traffic for inflatable penile prosthesis increased following the pandemic in the US. Nevertheless, post-pandemic, individuals with lower income levels showed no change in interest in penile implant searches compared to the pre-pandemic period. Understanding this steadiness in interest can inform healthcare professionals and policymakers to tailor interventions and educational efforts to reach a broader audience, ensuring equitable access to information and healthcare resources.
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Affiliation(s)
| | - Hana Nakamura
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Jake A Miller
- Department of Urology, University of California, Irvine, CA, USA
| | - Supanut Lumbiganon
- Department of Urology, University of California, Irvine, CA, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Babak K Azad
- Department of Urology, University of California, Irvine, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA
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3
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Armany D, Katelaris A, Dhar A, Alghazo O, Wood D, Kim LH, Patel MI. Telehealth vs face-to-face consultations in a urological oncology clinic: a randomised controlled trial. BJU Int 2025; 135 Suppl 3:37-43. [PMID: 39631365 DOI: 10.1111/bju.16615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
OBJECTIVES To determine the effectiveness of telehealth, among patients reviewed for urological oncological diseases, compared with standard face-to-face (F2F) consultations with regard to patient-reported satisfaction through use of a validated questionnaire. MATERIALS AND METHODS We conducted a single-centre randomised controlled trial in 126 patients recruited from the Crown Princess Mary Cancer Centres urological oncology clinics. Patients were randomised to either a telehealth audio-only (telephone) consultation group or a standard F2F consultation group for their next routine appointment. Validated questionnaires, using a 4-point Likert index scale, were completed at the end of the appointments. Questionnaire scores were analysed using the Mann-Whitney U-test. The primary outcome measured was patients' preference for type of consultation on subsequent follow-up. Secondary outcomes involved evaluation of efficiency, quality of care, ease of understanding, overall satisfaction, professionalism, limitations, and convenience. RESULTS A total of 63 patients in the F2F group and 53 patients in the telephone group completed and returned the validated questionnaires. Patients' preference for next follow-up was statistically significant, favouring the telephone group (P = 0.012). For the secondary outcomes, patients in the telephone group also reported greater satisfaction with regard to the efficiency and timing of the consultation (P = 0.005). Conversely, patients in the F2F group reported higher rates of satisfaction with regard to 'tests and follow-up' and the clinician's ability to deal with their issues, as compared to the telephone group (P = 0.002). Also, patients in the F2F group reported higher rates of perceived quality of consultation (P = 0.027). CONCLUSION Our study demonstrates that patients with urological oncological diseases attending routine follow-up generally prefer telehealth over F2F appointments. However, patients in the F2F group perceived that there was a higher quality of care in their consultation, and that the services provided were superior, in comparison to patients in the telehealth group. These are barriers to the widespread adoption of telehealth in urological oncology follow-up care and are rarely reported in the current literature.
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Affiliation(s)
- David Armany
- Department of Urology, Westmead Hospital, Sydney, Australia
| | | | - Ankur Dhar
- Department of Urology, Westmead Hospital, Sydney, Australia
| | - Omar Alghazo
- Department of Urology, Westmead Hospital, Sydney, Australia
| | - Dale Wood
- Department of Urology, Westmead Hospital, Sydney, Australia
| | - Lawrence H Kim
- Department of Urology, Westmead Hospital, Sydney, Australia
- Speciality of Surgery, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia
- Speciality of Surgery, University of Sydney, Sydney, Australia
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Fadaizadeh L, Velayati F, Arab-Zozani M. Satisfaction of Patients and Physicians with Telehealth Services during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Healthc Inform Res 2024; 30:206-223. [PMID: 39160780 PMCID: PMC11333811 DOI: 10.4258/hir.2024.30.3.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/13/2024] [Accepted: 07/25/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES The rapid spread of coronavirus disease 2019 (COVID-19) posed significant challenges to healthcare systems, prompting the widespread adoption of telehealth to provide medical services while minimizing the risk of virus transmission. This study aimed to assess the satisfaction rates of both patients and physicians with telehealth during the COVID-19 pandemic. METHODS Searches were conducted in the Web of Science, PubMed, and Scopus databases from January 1, 2020, to January 1, 2023. We included studies that utilized telehealth during the COVID-19 pandemic and reported satisfaction data for both patients and physicians. Data extraction was performed using a form designed by the researchers. A meta-analysis was carried out using random-effects models with the OpenMeta-Analyst software. A subgroup analysis was conducted based on the type of telehealth services used: telephone, video, and a combination of both. RESULTS From an initial pool of 1,454 articles, 62 met the inclusion criteria for this study. The most commonly used methods were video and telephone calls. The overall satisfaction rate with telehealth during the COVID-19 pandemic was 81%. Satisfaction rates were higher among patients at 83%, compared to 74% among physicians. Specifically, telephone consultations had a satisfaction rate of 77%, video consultations 86%, and a mix of both methods yielded a 77% satisfaction rate. CONCLUSIONS Overall, satisfaction with telehealth during the COVID-19 pandemic was considered satisfactory, with both patients and physicians reporting high levels of satisfaction. Telehealth has proven to be an effective alternative for delivering healthcare services during pandemics.
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Affiliation(s)
- Lida Fadaizadeh
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Farnia Velayati
- Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand,
Iran
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Khera M, Bernie HL, Broderick G, Carrier S, Faraday M, Kohler T, Jenkins L, Watter D, Mulhall J, Raheem O, Ramasamy R, Rubin R, Spitz A, Yafi F, Sadeghi-Nejad H. Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper. J Sex Med 2024; 21:318-332. [PMID: 38430132 DOI: 10.1093/jsxmed/qdad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Gregory Broderick
- Department of Urology, Mayo Clinic Alix School of Medicine, Jacksonville, Florida 32224, United States
| | - Serge Carrier
- Surgical Department /Urology Division, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Martha Faraday
- Four Oaks Consulting, Berryville, VA 22611, United States
| | - Tobias Kohler
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lawrence Jenkins
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Daniel Watter
- Morris Psychological Group, P.A., Parsippany, NJ 07054, United States
| | - John Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States
| | - Omer Raheem
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California, CA 92653, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, CA 92660, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology, NYU Langone Grossman School of Medicine, New York, NY 10017, United States
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Dmochowski RR, Rovner ES, Kennelly MJ, Newman DK, Abedinzadeh L, Snyder D, Thomas E, Haag-Molkenteller C, Rosenberg MT. Study design of a phase 4, real-world study (COMPOSUR) to evaluate vibegron in patients with overactive bladder. BMC Urol 2023; 23:64. [PMID: 37095473 PMCID: PMC10124676 DOI: 10.1186/s12894-023-01240-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) is defined as urinary urgency accompanied by frequency and nocturia, with or without urge urinary incontinence (UUI). Vibegron, a selective β3-adrenergic receptor agonist approved in the US in December 2020, demonstrated efficacy in reducing symptoms of OAB and was safe and well tolerated in the 12-week EMPOWUR trial and its 40-week, double-blind extension trial. The goal of the COMPOSUR study is to evaluate vibegron in a real-world setting to assess patient treatment satisfaction, tolerability, safety, duration of treatment, and persistence. METHODS This is a 12-month, prospective, observational, real-world study, with an optional 12-month extension to 24 months, in the US assessing adults ≥ 18 years old starting a new course of vibegron. Patients must be previously diagnosed with OAB with or without UUI, symptomatic for ≥ 3 months before enrollment, and receive prior treatment with an anticholinergic, with mirabegron, or with a combination of an anticholinergic and mirabegron. Enrollment is performed by the investigator following exclusion and inclusion criteria guided by US product labeling, reinforcing a real-world approach. Patients complete the OAB Satisfaction with Treatment Questionnaire (OAB-SAT-q) monthly and the OAB Questionnaire short form (OAB-q-SF) and Work Productivity and Activity Impairment Questionnaire (WPAI:US) at baseline and monthly for 12 months. Patients are followed up via phone call, in-person visits, or telehealth (ie, virtual) visits. The primary endpoint is patient treatment satisfaction as determined by the OAB-SAT-q satisfaction domain score. Secondary endpoints include percent positive responses to individual OAB-SAT-q questions, additional OAB-SAT-q domain scores, and safety. Exploratory endpoints include adherence and persistence. DISCUSSION OAB leads to a significant decrease in quality of life, as well as impairment of work activities and productivity. Persistence with OAB treatments can be challenging, often due to lack of efficacy and adverse effects. COMPOSUR is the first study to provide long-term, prospective, pragmatic treatment data for vibegron in the US and the resultant effect on quality of life among patients with OAB in a real-world clinical setting. Trial registration ClinicalTrials.gov identifier: NCT05067478; registered: October 5, 2021.
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Affiliation(s)
- Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA.
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Chen J, Jarvi K, Lajkosz K, Smith J, Lau S, Lo K, Grober E, Samplaski MK. How far will they go? Distance and driving times that north American men travel to see a reproductive urologist. Andrologia 2022; 54:e14551. [PMID: 36054603 PMCID: PMC9787797 DOI: 10.1111/and.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/19/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022] Open
Abstract
Male factor infertility affects about 50% of infertile couples. However, male factor infertility is largely under-evaluated due to multiple reasons. This study is to determine the time men travel for fertility evaluation, and factors associated with driving longer. Data from the Andrology Research Consortium were analysed. Driving distance and time were calculated by comparing "patient postal code" with "clinic postal code", then stratified into quartiles. Patients with the longest driving times (> 75th percentile [Q4]) were compared with those having shorter driving times. Logistic regression analysis was used to identify factors associated with longer driving times. Sixteen clinics and 3029 men were included. The median driving distance was 18.1 miles, median driving time was 32 min, and Q4 driving time was 49 min. Factors correlated with having Q4 driving time were age > 30 years, native Indian and Caucasian race, body mass index (BMI) > 30 kg/m2 , history of miscarriage, children with previous partner, self-referral, prior vasectomy, and prior marijuana use. On logistic regression, males aged < 30 years were more likely to be in Q4 for driving time versus older males. Blacks and Asians were less likely to travel further than Caucasians. Overweight/obese men, those having children with previous partner, and with prior vasectomy were more likely to be in Q4 travelling time. Factors correlated with longer driving times include younger age, native Indian and Caucasian race, higher BMI, children with prior partner, and prior vasectomy. These may reflect groups that drive long distances for reproductive care. The study provides an opportunity to better access these groups and minimise their barriers to fertility care.
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Affiliation(s)
- Jian Chen
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Keith Jarvi
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Katherine Lajkosz
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - James Smith
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Susan Lau
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Kirk Lo
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Ethan Grober
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Mary K. Samplaski
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Wang HHS, Xu R, Nelson CP, Campbell J, Estrada CR, Kurtz MP. Hybrid Clinics: A New Model for Ambulatory Care to Reduce Infection Risk. Telemed J E Health 2022; 29:560-568. [PMID: 36036799 DOI: 10.1089/tmj.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To assess the viability of a hybrid clinic model combining in-person examination with video-based consultation to minimize viral transmission risk. Methods: Data were collected prospectively in a pediatric urology clinic for in-person visits from January to April 2018 ("classic") and hybrid visits from October to December 2020 of the COVID-19 pandemic ("hybrid"). Variables included provider, diagnosis, patient type, time of day, prior surgery, postoperative status, and decision-making for surgery. The primary outcome was "room time" or time in-person. The secondary outcome was "total time" or visit duration. Proportion of visits involving close contact (room time ≥15 min) was assessed. Univariate analyses were performed using the Wilcoxon rank-sum test and Fisher's exact test. Mixed models were fitted for visit approach and other covariates as fixed effects and provider as random effect. Results: Data were collected for 346 visits (256 classic, 90 hybrid). Hybrid visits were associated with less room time (median 3 min vs. 10 min, p < 0.001) but greater total time (median 13.5 min vs. 10 min, p = 0.001) as compared with classic visits. On multivariate analysis, hybrid visits were associated with 3 min less room time (95% confidence intervals [CIs]: -5.3 to -1.7, p < 0.001) but 3.8 min more total time (95% CI: 1.5-6.1, p = 0.001). Close contact occurred in 6.7% of hybrid visits, as compared with 34.8% of classic visits (p < 0.001). Conclusions: Hybrid clinic visits reduce room time as compared with classic visits. This approach overcomes the examination limitations of telemedicine while minimizing viral transmission, and represents a viable model for ambulatory care whenever close contact carries infection risk.
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Affiliation(s)
- Hsin-Hsiao S Wang
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rena Xu
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Julie Campbell
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
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Paesano N, Carrion DM, Autrán Gomez AM. Telemedicine use in current urologic oncology clinical practice. Front Surg 2022; 9:885260. [PMID: 36338631 PMCID: PMC9629354 DOI: 10.3389/fsurg.2022.885260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In the last fifteen years, there have been important technological advances in telehealth systems and urology, along with other specialties, has been a pioneer in the successful use of this medical care modality. Due to the COVID-19 pandemic, the use of telemedicine has been rapidly embraced by the urology community around the world. A review of the most relevant and updated articles on telemedicine and telehealth in urology has been carried out with the aim of better understanding how it has been implemented to date, as well as reviewing concepts, current regulations, health policies and recommendations for its implementation. METHODS A narrative review of the current literature published up to April 2022 on the use of telemedicine in urology was performed. From the search results, 42 publications were obtained for analysis. RESULTS Telemedicine in urology has been shown to be useful in a variety of clinical scenarios within urological practice, from benign diseases to advanced cancers. This is due to the positive impact on medical consultation times, lower patient mobility costs, less work absenteeism and greater protection for both the patient and the doctor. The main limitations for the use of telemedicine lie in the impossibility of a correct physical examination, which is essential in certain situations, as well as the lack of accessibility to technology in disadvantaged populations and in elderly patients who have not adapted to the use of technology, as well as the lack of development of health policies to establish their implementation in some countries. CONCLUSION Telemedicine is in full growth. There is much information in the current literature on the successful adoption of telemedicine for patients suffering from urological diseases. While the use and implementation of these new practices has been rapid in the urology community, more work is needed to bring more accessible specialty care to underserved and underdeveloped areas. Health policies must promote its development to reduce costs and increase access.
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Affiliation(s)
- Nahuel Paesano
- Department of Urology, Instituto Médico Tecnológico, Prostate Institute Barcelona, CIMA—SANITAS Hospital, Barcelona, Spain,Office of Residents and Young Urologists, Office of Residents and Young Urologists of the American Confederation of Urology (CAU), Barcelona, Spain,Correspondence: Nahuel Paesano
| | - Diego M. Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain,Department of Urology, Instituto de Cirugía Urologica Avanzada (ICUA), Clínica CEMTRO, Madrid, Spain
| | - Ana María Autrán Gomez
- Department of Urology, Lyx Urology, Madrid, Spain,Office of Research, Office of Research of the American Confederation of Urology (CAU), Madrid, Spain
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10
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Shee K, Liu AW, Yarbrough C, Branagan L, Pierce L, Odisho AY. Identifying Barriers to Successful Completion of Video Telemedicine Visits in Urology. Urology 2022; 169:17-22. [PMID: 35981658 PMCID: PMC9376975 DOI: 10.1016/j.urology.2022.07.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/31/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The utilization of video telemedicine has dramatically increased due to the COVID-19 pandemic. However, significant social and technological barriers have led to disparities in access. We aimed to identify factors associated with patient inability to successfully initiate a video visit across a high-volume urologic practice. MATERIALS AND METHODS Video visit completion rates and patient characteristics were extracted from the electronic medical record and linked with census-level socioeconomic data. Associations between video visit failure were identified using multivariate regression modeling and random forest ensemble classification modeling. RESULTS 6,086 patients and their first video visits were analyzed. On multivariate logistic regression analysis, Hispanic or Latino patients (OR 0.52, 95%CI 0.31-0.89), patients insured by Medicare (OR 0.46, 95%CI 0.26-0.79) or Medicaid (OR 0.50, 95%CI 0.29-0.87), patients of low socioeconomic status (OR 0.98, 95%CI 0.98-0.99), patients with an un-activated MyChart patient portal (OR 0.43, 95%CI 0.29-0.62), and patients unconfirmed at appointment reminder (OR 0.68, 95%CI 0.48-0.96) were significantly associated with video visit failure. Patients with primary diagnosis category of men's health (OR 47.96, 95%CI 10.24-856.35), and lower urinary tract syndromes (OR 2.69, 95%CI 1.66-4.51) were significantly associated with video visit success. Random forest analyses identified insurance status and socioeconomic status as the top predictors of video visit failure. CONCLUSIONS An analysis of a Urology video telemedicine cohort reveals clinical and demographic disparities in video visit completion and priorities for future interventions to ensure equity of access. Our study further suggests that specific urologic indications may play a role in success or failure of video visits.
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Affiliation(s)
- Kevin Shee
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Andrew W Liu
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA
| | - Carol Yarbrough
- Telehealth Resource Center, University of California, San Francisco, San Francisco, CA
| | - Linda Branagan
- Telehealth Resource Center, University of California, San Francisco, San Francisco, CA
| | - Logan Pierce
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Anobel Y Odisho
- Department of Urology, University of California, San Francisco, San Francisco, CA; Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA.
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Naik N, Hameed BMZ, Nayak SG, Gera A, Nandyal SR, Shetty DK, Shah M, Ibrahim S, Naik A, Kamath N, Mahdaviamiri D, D'costa KK, Rai BP, Chlosta P, Somani BK. Telemedicine and Telehealth in Urology-What Do the 'Patients' Think About It? Front Surg 2022; 9:863576. [PMID: 35495745 PMCID: PMC9051070 DOI: 10.3389/fsurg.2022.863576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023] Open
Abstract
Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
| | - B. M. Zeeshan Hameed
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Father Muller Medical College, Mangalore, India
| | - Sanjana Ganesh Nayak
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Anshita Gera
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | | | - Dasharathraj K. Shetty
- Department of Humanities and Management, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Milap Shah
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Sufyan Ibrahim
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Aniket Naik
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Nagaraj Kamath
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Delaram Mahdaviamiri
- Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kenisha Kevin D'costa
- Department of Biomedical Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, India
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to discuss the impact of Coronavirus Disease 2019 (COVID-19) on the evolution of telemedicine use for urology office visits. RECENT FINDINGS The COVID-19 pandemic has caused a dramatic change in the delivery of healthcare. Fraught with numerous barriers previously, the need for healthcare delivery during a time of social distancing and increased healthcare requirements drove the adoption of telemedicine forward. This 'trial period' over the last year has allowed us to appreciate the potential utility of telehealth-associated services in practice and consider its role even after the pandemic. Multiple studies equating its utility to in-person visits whereas simultaneously providing added convenience and cost-related savings have been published in the urologic literature. Permanent regulatory changes will need to be implemented to allow us the flexibility to use telehealth in the future. SUMMARY It is clear that telemedicine is an effective strategy for delivery of healthcare under the right circumstances. Although it initially started to fill a need out of necessity, it can help us effectively deliver healthcare as long as the regulations surrounding telemedicine allow us to continue to use it. This period has been challenging for healthcare delivery and led to policy changes that served as a catalyst to help us better understand this previously underutilized resource.
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Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
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Edgerley S, Zhu R, Quidwai A, Kim H, Jeimy S. Telemedicine in allergy/immunology in the era of COVID-19: a Canadian perspective. Allergy Asthma Clin Immunol 2022; 18:16. [PMID: 35189969 PMCID: PMC8860358 DOI: 10.1186/s13223-022-00657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/08/2022] [Indexed: 01/10/2023] Open
Abstract
Background In the era of COVID-19, utilization of telemedicine has dramatically increased. In addition to reduced travel times, patient expenses, and work or school days missed, telemedicine allows clinicians to provide continued care while minimizing face-to-face interactions, maintaining social distancing, and limiting potential COVID-19 exposures. Clinical Immunology and Allergy (CIA), like many specialties, has adapted to incorporate telemedicine into practice. Previous studies have demonstrated similar patient satisfaction between virtual and in-person visits. However, evidence from fully publicly funded health care systems such as Canada has been limited. Methods We performed a quality improvement (QI) initiative to assess the feasibility of telemedicine. Between 1 March and 30 September 2020, patient encounters of two academic allergists at a single institution in London, Ontario, Canada were analyzed. Assessments were categorized into in-person or telemedicine appointments. A random sample of patients assessed virtually completed a voluntary patient satisfaction survey. Qualitative analysis was performed on survey comments. Results In total 3342 patients were seen. The majority were adults (n = 2162, or 64.7%) and female (n = 1872, or 56%). 1543 (46.2%) assessments were virtual and 1799 (53.8%) assessments were in-person. 67 of 100 random patient surveys sent to those in the virtual assessment group were completed. 89.6% (n = 60) agreed or strongly agreed when asked if they were satisfied with their telemedicine visit. 64.2% (n = 43) felt they received the same level of care compared to in-person assessments and 91% (n = 61) stated they would attend another virtual appointment. 95.4% (n = 62) of patients reported saving time with virtual assessment, the majority (n = 42, 62.7%) estimating between 1–4 h saved. Reported shortcomings included technical difficulties, “feeling rushed”, and missing in-person interactions. Conclusions Our quality improvement initiative demonstrated high patient satisfaction and time savings with virtual assessment in a publicly funded health care system. Studies suggest that CIA may be uniquely situated to benefit from permanent integration of virtual care into regular practice for both new and follow-up appointments. We anticipate continued increased utilization of telemedicine, signifying a lasting beneficial change in the delivery of healthcare.
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Testosterone replacement therapy in the era of telemedicine. Int J Impot Res 2022; 34:663-668. [PMID: 34799712 PMCID: PMC8604198 DOI: 10.1038/s41443-021-00498-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.
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Shin C, Allen AZ, Zhu D, Tellechea L, Watts KL, Abraham NE. Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center. Neurourol Urodyn 2021; 40:1834-1844. [PMID: 34342368 DOI: 10.1002/nau.24759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. METHODS A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. RESULTS One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. CONCLUSION Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.
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Affiliation(s)
- Christina Shin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ariel Z Allen
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laura Tellechea
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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Allen AZ, Zhu D, Shin C, Glassman DT, Abraham N, Watts KL. Patient Satisfaction with Telephone Versus Video-Televisits: A Cross-Sectional Survey of an Urban, Multiethnic Population. Urology 2021; 156:110-116. [PMID: 34333039 DOI: 10.1016/j.urology.2021.05.096] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/16/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. METHODS A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. RESULTS A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction. CONCLUSION Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.
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Affiliation(s)
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Nitya Abraham
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY; Department of Gynecology, Urogynecology Division, Montefiore Medical Center, Bronx, NY
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY.
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The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105338. [PMID: 34067818 PMCID: PMC8156025 DOI: 10.3390/ijerph18105338] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 02/08/2023]
Abstract
The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic.
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